不同培训方式对白内障超声乳化手术学习曲线的影响

目的探讨在白内障超声乳化手术学习中,采用不同培训方式对手术掌握程度及并发症发生的影响。方法 2007年7月至2009年3月,我们对参加奥比斯-博士伦白内障临床手术进修奖学金培训项目的10名学员进行白内障超声乳化手术的理论和实践技能培训。前5名学员（基本组B组）采用项目提供的理论讲解、观摩手术、动物实验和分阶段临床实践的方案进行学习,后5名学员（改进组A组）改进原有教学方案,重点讲解手术步骤规范化的作用、手术并发症的产生原因、处理和预防以及良好心理适应能力的培养。对两组学员的理论学习、动物实验结果及白内障超声乳化手术的基本步骤掌握程度进行评估。对两组学员的白内障超声乳化手术时间、手术能量应用、手术操作及并发症发生情况进行对比分析。结果两组学员经过理论学习、观摩手术和动物实验后,能够掌握白内障超声乳化手术的基本操作步骤,经过分阶段临床实践后,能独立完成白内障超声乳化手术。两组的前50例白内障超声乳化手术的手术能量、术后角膜水肿及人工晶状体的位置存在差距（P〈0.05）,改进组后囊膜破裂的发生率（16%）低于基本组（32%）。结论学习白内障超声乳化手术技术应遵守循序渐进的学习规律,规范的手术培训有利于缩短学习曲线,减少并发症的发生,成功实现向超声乳化手术的转换。

Effect of learning curve of phacoemulsication cataract surgeries with different training methods

Objective To investigate the effect of operative skills and the related complications of phacoemulsication cataract surgeries at early learning stage,to explore the better access of two different teaching methods.Methods From Jul,2007 ～ Mar,2009,10 fellow aided by the ORBIS and BL cataract surgry training program were dived into two groups.Learning included attending lectures（theoretical study）,observing surgery,animal experiments（wet lab） and actually practices,respectively.The first 5 fellow（base group,B group） was taught followed with the courses come from the program.The followed 5（advanced group,A group） fellow was taught with advanced courses of which aimed at the effect of standard operations,the keys of complations and good mental adaptation ability.To evelate the study of the lectures,Results of animal experiments,the degree of the knowledges of phacoemulsication cataract surgeries and the Results of the operations of first 50 cases.Case notes were prospectively compared.The data analyzed included ofintraoperative and postoperative complications,the time and the energy of the surgeries and final best corrected visual acuity（BCVA）.Results With the study of lectures,observing surgery and animal experiments,all fellow mastered the basic operating principles.After the actually practices,all of them completed phacoemulsication cataract surgery individually.Difference were found in the time of the surgeries,corneal edema and intraocular lens location between two groups.（P 0.05）,Posterior capasular rupture of A group（16%） was better than that of B group（32%）.Conclusion Phacoemulsification could be a safe procedure of learning step by step,training followed an appropriate programme.The successful transition to phacoemulsification would be completed.